Healthcare Provider Details

I. General information

NPI: 1578078622
Provider Name (Legal Business Name): JENNIFER K OWEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER K GOODWIN

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 E STEARNS ST STE 110
FAYETTEVILLE AR
72703-6196
US

IV. Provider business mailing address

1651 E STEARNS ST STE 110
FAYETTEVILLE AR
72703-6196
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-8550
  • Fax: 479-208-4266
Mailing address:
  • Phone: 479-876-8550
  • Fax: 479-208-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12699
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-760
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: